RTS - lungs community Flashcards
Red flags of cough?
Chest pain/pain on breathing in Wheezing/SOB Chronic cough (>3 weeks) Recurring cough Haemoptysis Weight loss Purulent sputum Fever
Colds in Patients with Respiratory Diseases -
Summary
Avoid respiratory depressants if disease severe
• E.g. cough suppressants
• Asthma
• Avoid NSAIDS unless patient taken safely previously
Recommend:
• Paracetamol
• Honey and lemon
• Steam inhalation
Strains and Sprains in Patients with
Respiratory Diseases
Check severity of disease e.g. breathlessness, hospital admissions
Avoid opioids where breathing impaired
• Check allergies i.e. have they taken ibuprofen/aspirin before?
Avoid NSAIDs in asthmatics unless tolerance already established
• Advise them to manage injury using PRICE
protect, rest, ice, compress, elevate
Head lice in Patients with Asthma
Aqueous solutions- Don’t irritate skin or lungs e.g. Hedrin®
don’t use alcoholic solutions
Hayfever in Patients with Respiratory Diseases
Sedating antihistamines
Not recommended in some respiratory conditions due to
anticholinergic effects drying up secretions causing mucus plugs
• Use non-sedating antihistamines e.g. cetirizine, loratadine
• Use nasal/eye preparations if possible to treat locally and minimise
side effects
what are symptoms that respiratory patients can show?
insomnia
- check plasma levels and theophylline
thrush
-Give fluconazole or miconazole oral gel
tiredness
-deterioration in COPD - REFER
nausea
- side effects of drugs - theophylline
check levels of theophylline
tremor/palpitation
-recommend omeprazole, antacid
heartburn
-theophylline/salbutamol side effect
review treatment
Theophylline interactions with OTC Preparations
Cimetidine + Fluconazole –> increased levels of theophylline
St John’s Wort —> decreased level of theophylline
therefore AVOID
name some drugs which increase theophylline levels
- Macrolides
- Quinolones
- Fluvoxamine
- Calcium channel blockers
what are examples of drugs that decrease levels of theophylline
- Rifampicin
- Phenobarbital
- Phenytoin
drugs which lower potassium
Corticosteroids
• High dose beta2 agonists
• Diuretics
Supporting Patients with Respiratory Disease:
what is SIMPLE and explain each
Stop smoking
- Inhaler technique
- Monitoring
- Pharmacotherapy
- Lifestyle
- Education
- Avoid extremes of temperature
- Vaccinations
- Take time to relax
Smokers respond less to asthma treatment
• Reduces rate of decline of COPD and improves survival rate
• Support tools available e.g. Smokefree NHS
• Smokers taking theophylline generally tend to require higher doses than nonsmokers as tobacco smoke contains polycyclic hydrocarbons, which induce
CYP1A2
• Smoking cessation will therefore result in an increase in serum theophylline
concentrations, and possibly toxicity
inhaler technqiue
Pharmacists can really make a difference in this area by
ensuring that any person prescribed an inhaler for the first
time knows how to use the device correctly
• Recognise that people can pick up bad habits and ongoing
technique should be confirmed at every opportunity
monitoring
Pharmacists can play an important role in encouraging people
with asthma to attend their medical practice for their review.
• People identified as being at high risk of severe asthma should
be closely monitored and pharmacists should be aware of the
features that increase the risk of asthma exacerbations and
death (such as recent hospital admission)
pharmacotherapy
Where LABAs are prescribed for people with asthma, they should be prescribed with concomitant ICSs, ideally in a
single inhaler device, and pharmacists can ensure this
• ICS should be prescribed for all symptomatic people with
asthma
• ICS should never be used as monotherapy in COPD
lifetstyle
Allergy – an avoidable factor e.g. animals, food, seasonal, drugs
Pharmacists can refer asthma patients with allergies to Allergy UK
50% of asthma deaths were in patients with a BMI over 25 (National
Review of Asthma Deaths (NRAD))
Pharmacists should encourage patients to adopt a healthy lifestyle and
support weight reductio
exercise
• Beneficial in both COPD and asthma if kept within aerobic range and
environmental conditions correct.
• Can result in significant improvement in a COPD sufferer’s quality of
life
• Asthmatics may need to inhale 200 micrograms salbutamol (2 puffs)
15 minutes prior to exercise
• Swimming, running or fast walking best
• Link between obesity and respiratory diseases
• Increased risk of asthma
Reduced fruits, vegetables and fish
Increased saturated fats
Fast foods
High regular intake of sugary drinks
-nutrution
(bronchoconstriction - egg, nuts,cheese + bronchodilation - mg, low dose alcohol, caffiene)
education
Pharmacists should ensure that all their
patients with asthma have a written personal
asthma action plan which they understand
and use
Pharmacists should encourage COPD
patients to recognise when they’re getting
worse and see the doctor
Doctors may give them a reserve course of
antibiotics/steroids for self treating at home
- Pharmacotherapy - Evidence Based Medicine
Where LABAs are prescribed for people with asthma, they should be prescribed with concomitant ICSs, ideally in a
single inhaler device, and pharmacists can ensure this
• ICS should be prescribed for all symptomatic people with
asthma
• ICS should never be used as monotherapy in COPD
Deterioration in Respiratory
Condition - Things to look out for
drug related NSAIDs • Aspirin • Beta blockers • Remember topical administration too • Drug interactions
Infection/Surgery/Trauma
May need to increase bronchodilator
• May need extra steroid e.g. short course of prednisolone
